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Treat to target in axial spondyloarthritis: From its concept to its implementation.
Journal of Autoimmunity ( IF 7.9 ) Pub Date : 2020-01-08 , DOI: 10.1016/j.jaut.2019.102398
Maxime Dougados 1
Affiliation  

Treat to target is defined by a process defining a level of a relevant outcome of the disease to be reached in order to prevent subsequent disability The benefit of a Treat to Target strategy has been clearly demonstrated in chronic diseases such as diabetes and hypertension. A better knowledge of the natural history of chronic inflammatory rheumatic diseases including axial spondyloarthritis has emphasized the deleterious long term effect of a sustained inflammation, usually evaluated by disease activity markers. The Treat to Treat strategy in axial spondyloarthritis has emerged since the possibility of getting treatments not only capable to improve the current symptomatic situation of the patient but also to prevent further deleterious irreversible hard endpoints such as disability due to structural damage or important comorbidities such as renal failure or cardiovascular diseases. This is particularly the case for the "conventional" biologics (e.g. TNF blockers) with an experience in daily practice for at least two decades but also for more recent biologics (e.g. anti IL17 inhibitors) and for some promising targeted synthetic Disease Modifying AntiRheumatics Drugs (e.g. JAK kinase inhibitors) moreover, a part from the abrogation of inflammation, other targets can be considered such as smoking cessation, NSAID intake reduction or treatment of predisposing factors of cardiovascular diseases (e. g. hypertension, …). A Treat to Target strategy in axial spondyloarthritis has to consider the following different components:the stages of the disease, the risks of the disease, the reversible predisposing factors of the risks of the disease, the optimal threshold of the outcome measures evaluating the predisposing factors (TARGET), the time to reach the target and the necessity to maintain this success (sustainability). Moreover, the different methods/initiatives facilitating the implementation of a Treat to Target strategy in rheumatological daily practice have also to be considered (level of evidence, international recommendations, importance of the patient's participation, …).

中文翻译:

治疗中轴性脊柱关节炎的目标:从概念到实施。

目标治疗是通过定义要达到的疾病的相关结果水平的过程来定义的,以防止随后的残疾。目标治疗策略的益处已在慢性疾病(如糖尿病和高血压)中得到明确证明。对包括中轴性脊柱关节炎在内的慢性炎症性风湿病自然史的更好了解强调了持续炎症的有害长期影响,通常通过疾病活动标志物进行评估。治疗中轴性脊柱关节炎的治疗策略已经出现,因为获得治疗的可能性不仅能够改善患者当前的症状状况,而且能够预防进一步有害的不可逆硬终点,例如由于结构性损伤或重要的合并症(如肾病)导致的残疾。失败或心血管疾病。对于具有至少 20 年日常实践经验的“常规”生物制剂(例如 TNF 阻滞剂)以及最近的生物制剂(例如抗 IL17 抑制剂)和一些有前景的靶向合成疾病修饰抗风湿药物尤其如此(例如 JAK 激酶抑制剂)此外,作为消除炎症的一部分,可以考虑其他目标,例如戒烟,NSAID 摄入量减少或治疗心血管疾病的诱发因素(例如高血压,...)。中轴性脊柱关节炎的治疗目标策略必须考虑以下不同的组成部分:疾病的阶段、疾病的风险、疾病风险的可逆诱发因素、评估诱发因素的结果测量的最佳阈值(TARGET)、达到目标的时间以及保持成功的必要性(可持续性)。此外,还必须考虑促进在风湿病日常实践中实施治疗目标策略的不同方法/举措(证据水平、国际建议、患者参与的重要性……)。中轴性脊柱关节炎的治疗目标策略必须考虑以下不同的组成部分:疾病的阶段、疾病的风险、疾病风险的可逆诱发因素、评估诱发因素的结果测量的最佳阈值(TARGET)、达到目标的时间以及保持成功的必要性(可持续性)。此外,还必须考虑促进在风湿病日常实践中实施治疗目标策略的不同方法/举措(证据水平、国际建议、患者参与的重要性……)。中轴性脊柱关节炎的治疗目标策略必须考虑以下不同的组成部分:疾病的阶段、疾病的风险、疾病风险的可逆诱发因素、评估诱发因素的结果测量的最佳阈值(TARGET)、达到目标的时间以及保持成功的必要性(可持续性)。此外,还必须考虑促进在风湿病日常实践中实施治疗目标策略的不同方法/举措(证据水平、国际建议、患者参与的重要性……)。疾病风险的可逆诱发因素、评估诱发因素的结果测量的最佳阈值 (TARGET)、达到目标的时间以及保持这种成功的必要性(可持续性)。此外,还必须考虑促进在风湿病日常实践中实施治疗目标策略的不同方法/举措(证据水平、国际建议、患者参与的重要性……)。疾病风险的可逆诱发因素、评估诱发因素的结果测量的最佳阈值 (TARGET)、达到目标的时间以及保持这种成功的必要性(可持续性)。此外,还必须考虑促进在风湿病日常实践中实施治疗目标策略的不同方法/举措(证据水平、国际建议、患者参与的重要性……)。
更新日期:2020-01-08
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